| |
3125 Main St Stevens Point WI 54481-3269 | |
(715) 254-9072 | |
(715) 254-9106 |
Full Name | |
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Speciality | Clinic/Center |
Location | 3125 Main St, Stevens Point, Wisconsin |
Authorized Official Name and Position | Erin Lamore (ENROLLMENT AND CONTRACT SPECIALIST) |
Authorized Official Contact | 9207879459 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 1440 Wautoma WI 54982-1440 Ph: (920) 787-5514 | 3125 Main St Stevens Point WI 54481-3269 Ph: (715) 254-9072 |
NPI Number | 1790786929 |
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Provider Enumeration Date | 08/10/2005 |
Last Update Date | 06/21/2024 |
Medicare PECOS PAC ID | 8729996574 |
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Medicare Enrollment ID | O20030331000042 |
Identifier | Type | State | Issuer |
---|---|---|---|
1790786929 | NPI | - | NPPES |
100253468 | Medicaid | WI | |
32955200 | Medicaid | WI | |
100080272 | Medicaid | WI | |
100224438 | Medicaid | WI | |
100076692 | Medicaid | WI | |
100084424 | Medicaid | WI | |
100076513 | Medicaid | WI |
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